The uninsured..........
 

http://www.pbs.org/newshour/indepth_...uninsured.html

Check out the country of origin. Almost half are non-citizens! Yet they deserve free US healthcare. Geez, with the 28th best healthcare in the world, why would they want to participate in our healthcare. Wouldn't they rather go to the Czech Republic, Northern Ireland, Portugal or Greece?

As usual, your logic is so stunningly juvenile as to hardly merit comment.

But that is an interesting article.

Go ahead and explain
 

what is juvenile about my logic? Or is it simply easier to name call? I know, that was a rhetorical question.

Here's a juvenile quote

85 % of the increase ;)

I'm a big believer in healthcare reform, but in fairness to the other side, the INCREASE in uninsured is the impetus behind the current debate. I'm surprised I've never heard this statistic.

I live in a country with socialized medicine. I am a proponent. I am laughing at the '85% of the increase'.

I have posted on this subject many times before ... how can a country that considers itself (through the exertion of political and military might) the moral centre of the universe have MILLIONS of it's citizens uninsured?

I know damn well what it said. If you're worrying about why the number of uninsureds are on the rise, there's your biggest culprit by far.

It is my opinion that malpractice suits are the major problem here. If not for these suits, health care would be a lot less expensive, and therefore people could afford it much more readily.

Health insurance is a moral issue?

Illegals don't need health insurance. They can get free medical care at any ER.

We should remove them from the equation.

YES! Who helps pay for the medical costs of the unfortunate in your respective Ward? YOU DO, if you pay fast offerings. I'm sorry, but you cannot dissect this issue in the hopes that you can support comfortable rationalizations!

"As of 2006, 15% of Americans (43.6 million) without any health insurance"

I agree -it is a major part of the problem.

I would argue that healthcare reform is a political/economic issue rather than a moral one. If we were letting people die in the streets, that's a moral issue. Despite what some would have you believe, this isn't happening--or at least, we're doing our best to prevent it. Medicaid is the best emergency care insurance in the world.

LINK! Do a search on this site in the political forum -you will find lot's of posts by many people and many links to many stats.

There have been links to stories in this ongoing discussion that proves people literally are being left to die because a lack of coverage.

Ask Mike for the links. It is first and foremost a moral issue.

Not actually ... actually look into it beyond the article ... what you might find will surprise you. What you are espousing is an excuse -you have your head in the sand.

ON my most recent plane flight I sat next to an ER dcotor for the Kaiser system. As I am a lawyer, we almost inevitbaly ended up discussing malpractice suits and their implications. Ay one point he asked me if I knew the biggest cause of malpractice suits. I rolled my eyes and said something like "greedy lawyers?" He said "Nope. Malpractice."

He was a very nice guy, actually, and his biggest gripe was not the outcome of these types of suits, but the unpredictability of the result.

Yeah, that would be wrong. Medicaid patients in this country have far better access to advanced technology in the emergency room than in any other country. Furthermore, it's illegal for an emergency room to deny care based on inability to pay. But it DOES make a good story.

Now if you're making an argument that their lack of preventive care is causing unneeded deaths, you may have a case. But the uncontrolled diabetic who eventually has an MI and dies isn't quite so newsworthy or exciting, although this is likely a much larger contributor to mortality.

Why do they lack preventative care? Well, that's a little trickier than just lack of insurance. The poor actually have access to Medicaid, but many are amazingly unwilling to make a phone call or visit the office to fill out the paperwork. Most primary care doctors take Medicaid, and most essential medicines are paid for by Medicaid. I guess we could fill out their paperwork for them too. On second thought, social workers often already do this. Maybe we need to wipe their butt...

Healthcare reform would do more for the lower-middle class than the lower classes.

I suspect he said that because he was talking to a lawyer and didn't want an awkward plane ride.

In reality, it's a combination of factors. Do you really think doctors in Louisiana are far worse than the doctors in Texas?

No, this was deep into the conversation and we had already reached agreement on many key points. He actually said it to make the point that he acknowledged that there were many meritorious claims that deserved compensation in some form. Like I said, the thing that bothered him was the widely disparate results.

I do think that juries can vary pretty dramatically in terms of their willingness to award damages (that is you, folks, not the lawyers) and this affects pretty dramatically how willing lawyers are to take marginal cases. So his point is a good one, I think.

So who sets up the rules? I know doctors have been clamoring for years that malpractice cases need to go before specialized juries, in the same way that patent law and other similar "expertise" issues do, only to run into opposition from...you guessed it...the American Bar Association.

My second complaint about malpractice involves the "profitable" suit. In other words, a bad result with a 40-yr old man with four kids will be snatched up by about any attorney regardless of what happened with the medical care because the potential reward is so high, and it will likely be settled out of court. This kind of thing could be controlled by expert preselection committees-groups of experts chosen to evaluate the merits of cases--this again has been strongly opposed by the American Bar Association.

And then there is the standard used. I truly believe the vast majority of doctors are doing the best they know how to do. But even the best makes a mistake. If I pay for a service and the provider of that service makes a mistake, that's an expected part of a human system. Grossly negligent mistake? Different story. Why isn't gross negligence the universal standard for malpractice? Are there other industries that are held to this strict of standard? (This is an honest question--I admittedly don't understand the law.)

Fix these three problems and medical costs will plummet. You have no idea how much CYA medicine costs.

THe profitable suit idea was included in what the guy I spoke with was tlakign about. What do you find objectionabel about that? If you make a mistake that kills a 40 year old provider for a family why should you not pay for it? Why should you get off th ehook as long as it wan't gross negligence (whatever that is; I suppose you would let the doctors decide what that means?)

You can say what you want, but it is a jury that awards the cash, not the lawyers.

As to other industries, you should ask people that make products what their standard is. It's called strict liability. So yes, other industries face similarly long (or longer) odds.

Our system is not perfect, and lawyers should shoulder their share of blame, but as to malpractice suits, the guy was right: the biggest cause of such suits is malpractice.

The problem is how outrageously large the awards they can be and how much in annual premiums doctors have to pay as a result.

Furthermore, what really is the most expensive end result of malpractice suits is it results in defensive medicine.

If there was a medical mistake involved, I absolutely think there should be significant compensation. If you look closely at the original question, I wrote "regardless of the medical care involved". Many lawsuits are picked up without any regard to whether a mistake was made or not, but with an eye to the potential out-of-court settlement. All I ask is that someone with any sort of expertise in medicine take a look at the case to decide that. Why are attorneys fighting this? If it's not greed, I'm not sure what it is.

The gross negligence standard is being tried in several states and has substantially reduced malpractice costs. That may or may not be desirable to you (I can see the argument against it), but it would decrease costs.

In the words of a most beloved poster here: Link? DO you have nay evidence of just how outrageously large the awards are (IOW, we all assume they are unjustifed; can you prove it)? And do you mena that such awards shouldnt happen ever, or do you mena they are only outrageous if they don't involve the death of a 40 year old father of 4, for example? And do you include awards in states where there are limits on malpractice awards for pain and suffering?

Moreover, the awards are from the juries. People like you (maybe not like you becasue you are, well, unique, but you get the idea) vote for them.

I like how people decry defensive medicine. But I WANT defensive medicine when it comes to treating or examining me or my family. I realize the odds say that I probabyl don't need some of these tests, and a prudent use of resources might not support it, but I don't want to be the loser in that game of chance. I prefer the thought that the doctor will check out possibilities becasue if he guesses incorrectly he might get sued.

I realize the cost of malpractice insurance is a problem, but I am not sure we really want to solve that problem without addressing other issues as well.

If I'm a liability insurer, I observe the range of possible claim amounts. In response to the claims distribution, I need to charge premiums sufficient to cover me if I get hit with particularly adverse claims experience.

When awards can reach the 8 figure level, that results in a siginificant amount of additional "risk premium" the insurer will charge its policyholders.

For example (and I'm just making up numbers for illustrative purposes), if the average malpractice claim cost per doctor per year is $100,000 but with a standard deviation of $600,000, you're going to see premiums well above $100,000 being charged.

The answer to the question of whethger medical care was faulty is the ultimate question. If you are contending that suits lacking any merit whatsoever are settled so frequently and for such significant sums that they dramatciually effect malpractice rates I would like to see the support for such a claim. I highly doubt this is true. If it is true, then your carrier needs to suck it up and try a few cases, becaseu a case lacking any merit will be defensed.

More likely you are talking about cases that you think have little merit but becasue the damages are so significant the small risk of an adverse liability result makes doctors pressure theiur carrier to settle before trial. This is reasonable conduct, of course, and is based not on a claim that lacks any merit, but is based on a claim that may be hard to prove or not have much meirt but which a jury, using the reasonable person standard and applying the burden of proof, might find professional negligence.

This is a very complex issue, and almost none of it is as black and white as you suggest.

I am sure it does reduce costs. I don't like it, becasue I don't think an access issue (which is what we started this thread talking about) should be solved by denying compensation to vicitms of mistakes. But I also admit I have not studies this at all (I do not practice MedMal) and so could be persuaded upon reviewing the approaches that are tried and how they work.

Sure, that's obvious, but that begs the question of what you mena by outrageous. What makes it outrageous? I assumed you meant unjustified. Do you mena anything large is outrgaeous regardless?

You THINK you want defensive medicine...

Your 3 yr old falls off the bunk bed. No loss of consciousness, small lump on the head, vomits once, but is now acting fine. You're scared because it's your kid so you bring him into the ER.

In Detroit, your kid gets a head CT. No way your child leaves the ER without one. Doesn't matter what your kid looks like. Doesn't matter what you want. You sign out against medical advice if you don't want one, and your visit will therefore likely not be covered by your insurance.

In Indiana, your child is examined. The doctor decides that the likelihood of your child having a significant head injury is low (say <2%--it's NEVER zero) and gives you instructions for watching him at home and what to watch for.

Now fast forward 30 years. In Detroit, your child develops a deadly thyroid carcinoma. You've totally forgotten about that head CT that likely caused it so you're not suing the doctor--you just write it off as something that happens.

Oh...and I didn't mention the little old lady who feels a little dizzy and is in the waiting room waiting for your kid to get out of the CT scanner so the doc can examine her, send her to discover her cerebral hemorrhage that will kill her. If only the doc could have gotten to her sooner. Oh well...avoided the lawsuit.

Oh yeah...there's also the increase in insurance premiums due to your kid and a thousand others that's going to make the blood pressure medicine unaffordable to the man who will die of a heart attack.

These are all huge issues that we face every day. I assure you I'm not painting the worst case. I've worked in Detroit and that is EXACTLY what happens. I've seen people die in the waiting room because the CT scanner was tied up with bullshit. We've all seen insurance premiums go up. And there are studies coming out every day about the dangers of radiation exposure from medical testing.

Defensive medicine is good for no one. But our hand is forced. After all, tests costs me nothing. Malpractice costs me a lot.

I could think of a hundred similar examples, I assure you. I practice this every day.

I agree that more of these suits need to be tried, and in fact, insurers are doing this more and more frequently. Hopefully, this is a problem that may solve itself.

The pressure to settle NEVER comes from a doctor. Any lawsuit settled makes your malpractice insurance more expensive. The commonest complaint in this arena is that the insurer was not willing to fight your case.

Overall, I don't have a problem with reasonable compensation for mistakes. I just want someone knowledgeable to decide if a mistake occurred. How is this different from patent law?

You should have been a trial lawyer. THis is exactly the sort of emotional approach that results in the so-called outrageous results you so dislike. You know very well that the range of defensive medcine rarely includes a CT and frequently includes other types of screeingin (blood tests, etc) that are not likely to cause rare and deadly carcinomas. Moreover, I expect a doctor to tell me the risks that are known for all treatment. If a docotr believes that a possible test has risks that are equivalent to or greater than the risk of the injury that might be detected, I expect to be told that. Are you suggesting, btw, that the 35 year old with cancer should be able to sue the docotr for that test? Mayeb this would, over time, result in the elimination of dangerous defensive testing?

This is amusing becasue it is so wildly incorrect. DO you think that insurance companies rush to throw money at plaintffs becaseu they are nice guys? The reason carriers beahve this way is becasue if they do not protect doctors (their insureds) they will be sued for bad faith. Indeed, the fact of large bad faith verdicts against carriers that failed to settle within limits when they had a chance to do so is exactly why they choose to settle now. In the case of medmal claims, can you venture a guess who it was that sued the carrier for bad faith? Here is a clue: it wasn't the injured party.

Are you kidding me? Overuse of CT's is one of the chief differences between us and the rest of the world. That's why this debate is raging right now in medicine. We all know we're ordering way too many CT's but until the malpractice situation is fixed, we're not stopping. Failure to CT is absolutely is one of the chief causes of lawsuits--whether it's head injury, appendicitis, bowel obstruction. I bet I order 5 needless CT's a shift; and I'm on the low end.

Yes, I think the doctor should be responsible for causing the thyroid carcinoma. Problem is, that's 30 yrs down the road--he's done practicing by then. What would you do in his place?

Need another example? You're 55. You come in with chest pain. It's sharp, lasted only a few minutes, no family history of heart disease. In Indiana, you're discharged, even knowing that there's always a small non-zero chance that you had a heart attack. In Detroit, you're either admitted to the hospital, or more likely, you're watched in the ER for 6-12 hours while serial tests are drawn. No, you don't have a choice, even though the chance this was a heart attack is next to nothing. You want to go home, you sign out against advice (and you'll cover that bill yourself). Wonder why the ER's are overcrowded?

I'm just getting started. If you think these are isolated examples, we can keep playing.

I haven't read this thread, but I will say having talked to a lawyer here in Texas that does occasional med malpractice suits as the plaintiff, that suits in Texas have gone way down since tort reform.

There is a lawsuit in practice that challenges the tort reform. It is brought by the relative of th former Dallas Cowboy who received a kidney from another former Dallas C. and is currently in a coma (?) after a minor surgical procedure.

You're really out of your realm here. The reason they're settling is the wildly disparate risk they're facing. That said, more and more are challenging them in court. I assure you that this is the chief complaint docs have about their carriers--their unwillingness to take things to court. I have yet to hear of a case of a bad-faith lawsuit. They may exist, but they're rare. I follow this issue pretty closely as ER is one of the higher liability fields--I'm sure if they were common, I would have read of several examples by now.

So what would be the approximate difference between Detroit and Indiana in charges billed to the insurer for the above scenarios?

Everson Walls and....

Health insurer or malpractice insurer?

Damn..I've really got to go.

I'll check this discussion out tonight.

Health insurer.